Are You Taking the Right Asthma Medication?

If you are one of the 22 million people in the United States who suffer from asthma, relief can't come fast enough during an attack.

That is why finding the right medication is of utmost importance.

Asthma is a chronic lung disease that causes recurrent inflammation and narrowing in the airways. Symptoms include wheezing, coughing and chest tightness, all of which are often worse at night, said Dr. Nathanael Horne, of Allergy and Asthma Medical PC and an assistant attending at St. Vincent’s Hospital, both of which are located in New York City.

Asthma triggers differ for each patient, but they include:

— Allergens, such as cat dander or tree pollen;

— Upper respiratory infections;

— Sinusitis;

— Acid reflux;

— Pollution;

— Exercise;

— Cold air.

“There is really no cure for asthma, although it can go into remission for an extended period of time,” Horne said.

There are two main categories of asthma medications: quick relievers or rescue inhalers, and controller (long-term control) medications, Horne said.

Rescue Inhalers

“Everyone with asthma should have one of these,” Horne said. “For young children there are oral forms, but usually there are inhalers or nebulizers.”

The most commonly used rescue inhaler is known as Proventil (albuterol), which relaxes the muscles around the airways in the lungs.

Atrovent is a less commonly used rescue inhaler, Horne said, and it works differently: While it still relaxes the muscles, it works more on the nerves.

“These inhalers don’t do anything about inflammation, so they don’t address the underlying problem,” he said. “For many people with mild asthma, that’s all they will need. If someone has severe asthma, they need more medication.”

Controller Medications

If you are having frequent or severe attacks, or you are using your inhaler more than twice a week, you may need to speak to your health care provider about adding a controller medication to your daily regimen, Horne said.

There are several classes of drugs within this category.

Corticosteroids. These are the mainstay drugs in treating asthma, and they are powerful anti-inflammatory medications. Examples include budesonide (inhaled) or prednisone (oral).

Designer steroids. “There are new therapies being designed all the time,” Horne said, “and some of these have very little systemic absorbtion, meaning they mostly have their effect in the lungs.” Horne said the latest drugs to catch the public’s attention is an inhaler known as Alvesco (ciclesonide).

Anti-leukotrienes. Leukotrienes are one of the inflammatory chemicals released by the body during an attack of seasonal allergies or in asthma. A drug like Singulair blocks the effects of the leukotrienes.

Mast cell stabilizers. When they are stimulated, the cells in the airways release inflammatory chemicals, Horne said. A mast cell stabilizer such as Intal (cromolyn) will keep the cells from activating. This drug can also be used for exercise-induced asthma.

Long-acting beta agonists. Examples include Serevent or Flovent, and they are known as bronchodilators — they relax the smooth muscles in the walls of the airways. This is done by stimulating the beta receptors that act against bronchoconstriction. Then there is Advair, which is a combination of these two medicines.

Monoclonal antibody. Xolair (omalizumab) is biologic medication, a specific antibody to block allergies. For that reason, it's very expensive, Horne said. It is administered via an injection every two to four weeks and is given only to people with allergic asthma.

Acid reflux medications. Sometimes an asthma patient can benefit from an antacid medication, even if they don’t feel the effects of heartburn, Horne said. They may have silent acid reflux, which can worsen or cause asthma symptoms. However, there is a definite connection.

"Controller medications can be used short periods or they can be used all the time," Horne said. "They just shouldn't be used alone during an acute asthma attack. That's when you use a rescue inhaler. The frequent mistake I see is when a patient is on (only) one inhaler like Advair with no rescue inhaler."

Horne suggested that people with asthma track their symptoms using a peak flow diary and asthma action plan, which includes measuring the severity of symptoms using a peak flow meter and then recording your results.